05.11.2020

Smart applications for home dialysis help the daily life of dialysis patients and medical staff

Nephrologist Virpi Rauta from the Abdominal Center of Helsinki University Hospital (HUS) is the leading researcher in the Home dialysis project of the CleverHealth Network, which conducts multidisciplinary research to improve the quality of life for kidney disease patients. The goal of this collaborative project is to identify the patients most suited for home dialysis therapy. The project also aims to ease the daily life of patients and medical staff with an intelligent monitoring application and devices that measure the well-being of the patient. Virpi Rauta shares the latest news about the project, launched in 2019.

CleverHealth Network is an innovation ecosystem processing and cultivating health and welfare data. It is funded by Business Finland and its member organisations. The ecosystem, consisting of companies and health care experts work together to develop world-class solutions based on the cultivation of healthcare data to solve clinical challenges. The aim is to create better care for patients and export product and service innovations developed by Finnish companies. The Home dialysis project is part of the eCare for Me project entity where HUS partners with companies (TietoEVRY, Kaiku Health, Intito, Gillie.AI and Vivago Oy) and universities (Aalto University and University of Helsinki).

The worldwide increase in the prevalence of dialysis challenges healthcare. A more cost-efficient home dialysis has been shown to improve the quality of life of patients, but it has not, surprisingly, increased at the same rate. The Home dialysis project led by HUS is looking into finding solutions to this challenge and ways to identify the patients suited for home dialysis at an early stage. The processes and tools under development can accelerate and ease the transition to home dialysis, which has so far been labour intensive and complex.

Smart solutions to treat and monitor kidney disease patients

In the Home dialysis project, the partners develop an application designed for the home dialysis process. The application can be used on smart phones or computer and helps in the monitoring activities related with renal care and it ensures that the communication between the patient and dialysis nurse and accessory orders take place smoothly and reliably.

In addition to a smart application, the project partners develop a series of meters and sensors to be used by the home dialysis patient. For example, they will be used to monitor the patient’s activity levels, fluid balance and general quality of life. The devices will also be able to identify any probability of risk events, and some of the devices will be able to send out automatic data and alerts to care personnel.

Accurate and predictive data will also be beneficial for pre-dialysis patients, whose dialysis therapy is at the planning stage and who typically visit hospital for check-ups every two or three months. Up until now, the monitoring of the patients in between follow-up visits has been challenging. Patient monitoring using Artificial Intelligence (AI) modelling will, at best,  help predict and even prevent serious adverse events, such as unplanned dialysis therapy performed in emergency care.

Participating in a dream project

Virpi Rauta is an active participant and speaker in the top expert forums and has established a wide network within the clinical professionals from Canada, Australia, New Zealand and Great Britain. Together with Finland, these countries are the global forerunners in the adoption of home dialysis.

Virpi’s ideas and extensive expertise on the topic ignited the Home dialysis project, making her the leading researcher in the project. Virpi finds working in the project extremely rewarding. Over the years, Virpi has researched the processes related to home dialysis and has noticed that the routines and accessory orders are surprisingly complex and time-consuming. She is delighted to be able to work on the home dialysis concept and its related processes and tools she has been thinking about for years, and, eventually, to be able to productise the concept. To start a home dialysis process from scratch is a very elaborate undertaking but when it is carefully conceptualised and automatised, it will be very beneficial also in those regions where home dialysis is not yet prevalent. Virpi works closely with many experts in this HUS-led project: project researcher Aleksei Teor, professori Patrik Finn, research clinician Wisam Bitar, research nurse Tiina Puurtinen, research nurses Pirgit Silvast-Äikäs and Anu Varila, and application designer Niina Kanerva and research assistant Eevi Bengs.

According to Virpi, the Home dialysis project demonstrates highly creative work that combines many professions and multi-disciplinary research. The project brings all-new academic research on four different areas: In addition to nephrology research in HUS, Aalto university engages in usability research and cost-effectiveness analyses, and University of Helsinki does socio-psychological motivation research. Virpi characterises the collaboration with company partners, TietoEVRY, Kaiku Health, Intito, Gillie.AI and Vivago Oy, as brilliant.

Virpi says: ”In this project, we are working with life sustaining care. If the patient can be elected to home-based dialysis, the outcomes are almost invariably much better, and also cost savings in care personnel resourcing as well as in general expenditure can be obtained.” Organ transplant is naturally the primary form of treatment, but it is not always a feasible option, and most of the patients suited for organ transplant will engage in dialysis therapy while waiting for a suitable organ.

According to Anja Kajanne, the project manager of the eCare for Me project entity, Virpi’s contagious enthusiasm has spread throughout the collaborative network. The research and development work of this life maintaining care is done in a positive atmosphere, which shows in the results. In the spring, the project members had to dedicate their time to corona critical tasks which delayed the progress of the project but now the project is back on track.

The upcoming years can expect concrete results from the project. The background material has already been collected and the analysis is starting. At the same time, the actual application and user interfaces with algorithms, alerts and predictive models are being developed in stages. Hundreds of patients will also be recruited to participate in prospective research. Next year, the project partners will get to hear user feedback from the patients and dialysis nurses piloting the devices.

Important innovations for the patient’s benefit

A remarkable benefit of the home-based dialysis is the possibility to customise the treatment according to patient’s needs. The dialysis patient can choose their preferred therapy type. Instead of visiting the hospital three times a week, for up to five hours at a time according to schedules defined by hospital, the care team will evaluate the lab results and  discuss with the patient to find the most feasible treatment for their life situation.

Special attention has been paid to the user friendliness of the devices created for the Home dialysis project. As reference, 26 per cent of the users on the digital DiaMy care path in Health Village are over 70 years old and this year-long experience has given indications that also the elderly patients will be able to use digital health care services. The usability experts of Aalto university will interview a large number of patients and partner companies to build an easy-to-use and automatised user interface for the Home dialysis project.

Considerable cost savings through home-based dialysis

The research conducted in various countries indicates that home-based dialysis is the most cost-effective option and a therapy form that improves the patient’s quality of life and therapy outcome.

Virpi Rauta has made various scenarios on the savings to be made through home dialysis and the results are quite startling.

In 2017, HUS saved 3.3 million € by treating 31 per cent of the dialysis patients in home-based care in comparison  compared to the situation where all patients would have had in-centre haemodialysis treatment. With the increase in the prevalence of dialysis patients, the role of home-based dialysis to generate cost savings in health care is becoming more important than ever. As the new processes become more common, more and more patients will hopefully choose the dialysis therapy done at home.

More Information

Anja Kajanne, Project Manager, HUS, anja.kajanne[at]hus.fi
Virpi Rauta, MD, Nephrologist, EMBA, PhD, Homedialysis, Nephrology, Abdominal Center, Helsinki University Central Hospital, virpi.rauta[at]hus.fi